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General NPI Number Information
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NPI Number | 1538500756
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Entity Type | Organization
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Legal Business Name | CB PHENIX REHABILITATION CENTER CORP
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 3750 W 16TH AVE SUITE 226-U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-557-6188
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Fax | 305-557-6199
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Provider Business Mailing Address
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Address Line | 3750 W 16TH AVE SUITE 226-U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-557-6188
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Fax | 305-557-6199
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Authorized Official
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Title or Position | OWNER
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Name | HUMBERTO MARTINEZ
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Credential | M.M
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Telephone | 305-557-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC7764
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License Number State | FL
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